Association of GLP-1 Receptor Agonist Use with Postoperative Outcomes After Rotator Cuff Repair in Patients with Diabetes: A Propensity Score–Matched Analysis

Authors

McKenna W. Box, HCA HealthcareFollow
Troy B. Puga, HCA HealthcareFollow
Hans Drawbert, HCA HealthcareFollow
Aysu Erdemir, HCA HealthcareFollow
John T. RiehlFollow

Files

Division

North Texas

Hospital

Medical City Denton

Specialty

Orthopedic Surgery

Document Type

Poster

Publication Date

2026

Keywords

GLP-1 receptor agonist, rotator cuff repair, diabetes, postoperative outcomes

Disciplines

Endocrine System Diseases | Medicine and Health Sciences | Orthopedics | Surgical Procedures, Operative

Abstract

Background Diabetes impairs tendon healing after rotator cuff repair (RCR), with early postoperative poor glycemic control linked to a higher failure risk in studies. GLP-1 receptor agonists (GLP-1RAs) are increasingly used for glycemic control. Preclinical studies indicate that GLP-1RA may benefit rotator cuff healing through anti-inflammatory mechanisms as well. However, real-world data on the effects of GLP-1RAs on RCR outcomes remain incompletely understood.

Methods We conducted a retrospective cohort study using an institutional dataset (01/01/2016 to 09/30/2024) of adults aged 18-74 years with type 2 diabetes who underwent RCR. GLP-1RA exposure was established by home medication lists. Patients with autoimmune diseases, type 1 diabetes, chronic kidney disease, myocardial infarction, associated shoulder-girdle fractures, or shoulder arthroplasty were excluded. Outcome measures were assessed up to 1 year after surgery and included ED visits, pneumonia, revision shoulder surgery for rotator cuff re-tear or conversion to arthroplasty, and postoperative stiffness. Propensity scores were estimated using logistic regression, and patients were matched 1:1 to patients with diabetes not on a GLP-1RA. Post-match balance was assessed using standardized mean differences. Post-matching outcomes were evaluated using bias-reduced logistic regression for rare events, with cluster-robust standard errors within matched pairs. The Benjamini-Hochberg false discovery rate adjustment was applied to all modeled outcomes.

Results Among 10,354 eligible patients, 1,689 (16.3%) were users of GLP-1RA. After application of exclusion criteria, 1,555 GLP-1RA users were matched with 1,555 non-users (N = 3,110). After multiplicity adjustment, GLP-1RA use was associated with higher odds of postoperative stiffness (OR 1.953, 95% CI 1.232-3.096; adjusted P = .048). No significant associations were observed for ED readmissions (30/90/365 days), pneumonia readmissions (90/365 days), revision RCR or conversion to arthroplasty (all adjusted P > .30). Other outcomes were not analyzable due to low event counts.

Conclusions In this propensity score-matched cohort of diabetic patients undergoing RCR, GLP-1RA use was not associated with differences in most short-term perioperative outcomes. A statistically significant association with postoperative stiffness within 1 year was observed. Overall, postoperative events were uncommon, and the finding should be interpreted as associative and hypothesis-generating for future studies.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Box, McKenna W.; Puga, Troy B.; Drawbert, Hans; Erdemir, Aysu; and Riehl, John T., "Association of GLP-1 Receptor Agonist Use with Postoperative Outcomes After Rotator Cuff Repair in Patients with Diabetes: A Propensity Score–Matched Analysis" (2026). North Texas Research Forum 2026. 47.
https://scholarlycommons.hcahealthcare.com/northtexas2026/47